Bellabarba, J Bone Joint Surg Am 2001 - Cementless Acetabular Reconstruction after Acetabular Fracture

Cementless Acetabular Reconstruction after Acetabular Fracture

Bellabarba, Galante, et al.·J Bone Joint Surg Am·2001·208 citations·Retrospective cohort

Background

Total hip arthroplasty in patients with posttraumatic arthritis has produced results inferior to those in patients with nontraumatic arthritis. The use of cementless acetabular reconstruction, however, has not been extensively studied in this clinical context. Our purpose was to compare the intermediate-term results of total hip arthroplasty with a cementless acetabular component in patients with posttraumatic arthritis with those of the same procedure in patients with nontraumatic arthritis. We also compared the results of arthroplasty in patients who had had prior operative treatment of their acetabular fracture with those in patients who had had prior closed treatment of their acetabular fracture.

Methods

30 total hip arthroplasties were performed with use of a cementless hemispheric, fiber-metal-mesh-coated acetabular component for the treatment of posttraumatic osteoarthritis after acetabular fracture.
The median interval between the fracture and the arthroplasty was 37 months (range, 8 to 444 months).
The average age at the time of the arthroplasty was 51 years (range, 26 to 86 years), and the average duration of follow-up was 63 months (range, 24 to 140 months).
15 patients had had prior open reduction and internal fixation of their acetabular fracture (open-reduction group), and 15 patients had had closed treatment of the acetabular fracture (closed-treatment group).
The results of these 30 hip reconstructions were compared with the intermediate-term results of 204 consecutive primary total hip arthroplasties with cementless acetabular reconstruction in patients with nontraumatic arthritis.

Results

Operative time (p < 0.001), blood loss (p < 0.001), and perioperative transfusion requirements (p < 0.001) were greater in the patients with posttraumatic arthritis than they were in the patients with nontraumatic arthritis.
Of the patients with posttraumatic arthritis, those who had had open reduction and internal fixation of their acetabular fracture had a significantly longer index procedure (p = 0.01), greater blood loss (p = 0.008), and a higher transfusion requirement (p = 0.049) than those in whom the fracture had been treated by closed methods.
8 of the 15 patients with a previous open reduction and internal fixation required an elevated acetabular liner compared with one of the 15 patients who had been treated by closed means (p = 0.005).
2 of the 15 patients with a previous open reduction and internal fixation required bone-grafting of acetabular defects compared with 7 of the 15 patients treated by closed means (p = 0.04).
The 30 patients treated for posttraumatic arthritis had an average preoperative Harris hip score of 41 points, which increased to 88 points at the time of follow-up; there was no significant difference between the open-reduction and closed-treatment groups (p = 0.39).
27 patients (90%) had a good or excellent result.
There were no dislocations or deep infections.
The Kaplan-Meier 10-year survival rate, with revision or radiographic loosening as the end point, was 97%.
These results were similar to those of the patients who underwent primary total hip arthroplasty for nontraumatic arthritis.

Conclusions

The intermediate-term clinical results of total hip arthroplasty with cementless acetabular reconstruction for posttraumatic osteoarthritis after acetabular fracture were similar to those after the same procedure for nontraumatic arthritis, regardless of whether the acetabular fracture had been internally fixed initially. However, total hip arthroplasty after acetabular fracture was a longer procedure with greater blood loss, especially in patients with previous open reduction and internal fixation. Previous open reduction and internal fixation predisposed the hip to more intraoperative instability but less bone deficiency.

Supplemental

Cementless Acetabular Reconstruction after Acetabular Fracture.

Bellabarba, Galante, et al.J Bone Joint Surg Am2001208 citationsRetrospective cohort